Insight into Dunbar syndrome: color-Doppler ultrasound findings and literature review

Acampora, Ciro; Serafino, Marco Di; Iacobellis, Francesca; Trovato, Piero; Barbuto, Luigi; Sangiuliano, Nicola; Costigliola, Luciana; Romano, Luigia

doi:10.1007/s40477-019-00422-0

Cited by 17 publications

(9 citation statements)

References 25 publications

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“…Doppler US allowed accurately identifying CA and LRV stenosis and also giving estimation of stenosis degree through measurement of FR. This latter value is very useful for therapeutic planning and prophylaxis: in fact a venous FR of 2.5 cm/s corresponds to a stenosis of 50% which allows to choice a therapeutic conservative approach for NCS [15] . Meanwhile, the US evaluation of CA in expiratory apnea, allows the diagnosis of MALS in case of FR greater than 3:1 or a PSV greater than 200 cm/s [15] .…”

Section: Discussionmentioning

confidence: 99%

A man with the rare simultaneous combination of three abdominal vascular compression syndromes: median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome

Farina¹,

Gozzo²,

Foti³

et al. 2021

Radiology Case Reports

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Median arcuate ligament syndrome and superior mesenteric artery syndrome are well-known abdominal compression syndromes, the coexistence of which is rarely described in literature. In addition, due to the common pathogenesis, anterior nutcracker syndrome may occur simultaneously to superior mesenteric artery syndrome. To our knowledge, this is the first case reporting combination of these 3 syndromes detected with ultrasound, Computed Tomography and upper gastrointestinal fluoroscopic exam. A 69-year-old man came to our attention for rapid weight loss, postprandial epigastric pain and recurrent vomiting for at least 6 months. Doppler ultrasound showed both celiac artery and left renal vein stenosis with simultaneous left varicocele. Computed tomography showed a reduction of aortomesenteric space causing both left renal vein and duodenal stenosis, this latter confirmed by upper gastrointestinal fluoroscopic exam. The diagnosis of these three vascular compression syndromes (MALS, SMAS, and anterior NCS) has been formulated, based on clinical and imaging findings. We assumed that the postprandial crises caused by median arcuate ligament syndrome may induce a reduction of meals consumption and progressive weight loss which can be a cause of anterior nutcracker syndrome and superior mesenteric artery syndrome onset. Doppler ultrasound, in expert hands, allows to accurately diagnosing these syndromes which are often underestimated. Failure to recognize it and inadequate treatment could have serious consequences for patients' health.

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Section: Discussionmentioning

confidence: 99%

A man with the rare simultaneous combination of three abdominal vascular compression syndromes: median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome

Farina¹,

Gozzo²,

Foti³

et al. 2021

Radiology Case Reports

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show abstract

“…CAS can be diagnosed by dynamic Doppler ultrasound, which examines blood flow velocity in the celiac axis during inspiration and expiration. Peak systolic velocity during expiratory apnea ultrasound should not exceed 200 m/s in healthy patients and can be considered typical of CAS if symptoms are present [ 47 ]. Further, contrast-enhanced CT (ideally performed in end expiration) can be used to highlight the stenotic part of the CA in image reconstruction and help diagnose CAS.…”

Section: Discussionmentioning

confidence: 99%

Surgical therapy of celiac axis and superior mesenteric artery syndrome

Jonas

Ghafoor

Kobe

et al. 2023

Langenbecks Arch Surg

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Introduction Compression syndromes of the celiac artery (CAS) or superior mesenteric artery (SMAS) are rare conditions that are difficult to diagnose; optimal treatment remains complex, and symptoms often persist after surgery. We aim to review the literature on surgical treatment and postoperative outcome in CAS and SMAS syndrome. Methods A systematic literature review of medical literature databases on the surgical treatment of CAS and SMAS syndrome was performed from 2000 to 2022. Articles were included according to PROSPERO guidelines. The primary endpoint was the failure-to-treat rate, defined as persistence of symptoms at first follow-up. Results Twenty-three studies on CAS (n = 548) and 11 on SMAS (n = 168) undergoing surgery were included. Failure-to-treat rate was 28% for CAS and 21% for SMAS. Intraoperative blood loss was 95 ml (0–217) and 31 ml (21–50), respectively, and conversion rate was 4% in CAS patients and 0% for SMAS. Major postoperative morbidity was 2% for each group, and mortality was described in 0% of CAS and 0.4% of SMAS patients. Median length of stay was 3 days (1–12) for CAS and 5 days (1–10) for SMAS patients. Consequently, 47% of CAS and 5% of SMAS patients underwent subsequent interventions for persisting symptoms. Conclusion Failure of surgical treatment was observed in up to every forth patient with a high rate of subsequent interventions. A thorough preoperative work-up with a careful patient selection is of paramount importance. Nevertheless, the surgical procedure was associated with a beneficial risk profile and can be performed minimally invasive.

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“…According to the literature, a PSV of the AC greater than 200 cm/s during the expiratory phase or a PSV ratio of the celiac artery to the aorta greater than 3: 1 in the expiratory phase are Doppler criteria for the diagnosis of DS. Some authors have described a borderline form of DS with only a slight increase in PSV (163.9 cm/s) without marked celiac compression in the US and CT [ 18 ]. The “hook sign”, shown by CT exam, is relatively common in daily practice, but in most cases it has no clinical significance.…”

Section: Discussionmentioning

confidence: 99%

The Role of Ultrasound in Dunbar Syndrome: Lessons Based on a Case Report

et al. 2020

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Patient: Male, 55-year-old Final Diagnosis: Dunbar syndrome Symptoms: Epigastric pain • weight loss Medication: — Clinical Procedure: None Specialty: Gastroenterology and Hepatology • Radiology Objective: Rare disease Background: Dunbar syndrome is a rare vascular alteration caused by the abnormal course of the median arcuate ligament of the diaphragm, which in some patients causes chronic compression of the celiac artery and can cause non-specific symptoms such as diarrhea, retro-sternal pain, vomiting, swelling, and nausea, or a typical symptomatic triad with weight loss, post-prandial abdominal pain, and epigastric murmur. Color Doppler ultrasound and duplex Doppler ultrasound provide a complete diagnostic framework of this disease. Case Report: We describe a case of 55-year-old man with post-prandial epigastric pain, significant weight loss, and several episodes of retro-sternal pain. He underwent multidetector computed tomography of the abdomen and color duplex Doppler ultrasound examination of the celiac artery that highlighted stenosis of the celiac artery, more severe in expiratory apnea. The computed tomography showed the typical aspect of the celiac artery, with the “hook sign”. A duplex Doppler ultrasound examination showed a significant increase in peak speed (226 cm/s) due to severe stenosis of the celiac artery by the median arched ligament of the diaphragm. Conclusions: This case is unique due to the severity of the celiac artery stenosis and the unusual clinical presentation of the patient who had frequent episodes of retro-sternal pain. The significant increase in peak velocity in the celiac artery in expiratory apnea, if associated with the typical symptomatology in the absence of other alterations of the splanchnic vessels, can be considered, in our opinion, sufficient for the diagnosis of Dunbar syndrome.

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Insight into Dunbar syndrome: color-Doppler ultrasound findings and literature review

Cited by 17 publications

References 25 publications

A man with the rare simultaneous combination of three abdominal vascular compression syndromes: median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome

A man with the rare simultaneous combination of three abdominal vascular compression syndromes: median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome

Surgical therapy of celiac axis and superior mesenteric artery syndrome

The Role of Ultrasound in Dunbar Syndrome: Lessons Based on a Case Report

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